Unknown Individual – Specialist, NPI 1497839575

Specialist

Unknown Individual is a healthcare provider. based in Panama city, Florida. specializing in Specialist. They hold a License No. 045933 (GA). The NPI Number for Unknown Individual is 1497839575

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1497839575

Phone

(850) 233-3376

Address

215 HARRISON AVE

Deactivation Date

6 August 2021

Doctor Profile

Medical School Name

AT STILL UNIVERSITY, ARIZONA SCHOOL OF DENTISTRY & ORAL HLTH

Secondary Phone

8772313376

Graduation Year

1979 (47 years ago)

PAC ID

3375500945

Group Practice PAC ID

9931277233

Professional Enrollment ID

I20041215000339

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience37

Completeness75

Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

215, Harrison Avenue, Panama City, Bay County, Florida, 32401, United States
PANAMA CITY, FL 324012727
Phone: (850) 233-3376
Fax: (850) 522-8354
Type: Mailing
2320, Double Churches Road, Fortson Terrace, Columbus, Muscogee County, Georgia, 31909, United States
STE B
COLUMBUS, GA 319092663
Phone: (706) 887-5050
Fax: (850) 522-8354
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32401)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9931277233View full group profile

Name	Specialty	State
ANGELA J PEARSON (N.P.)	Nurse Practitioner	IL
DR. JEFFREY B STRICKER (DO)	Dermatology, Pathology	FL
MISS HOLLY YATES VEZERTZIS (CRNP)	Nurse Practitioner	AL
ELIZABETH BROOKE DYLEWSKI	Physician Assistant	FL
HANNA THOMAS	Physician Assistant	FL
MS. ANGELA MARIE MERCER (PA-C)	Physician Assistant	FL
BRITTANY COX (FNP-C)	Nurse Practitioner	FL
KRISTI BYERS WELLS (PA-C)	Physician Assistant	FL
MRS. NICHOLE JOHNSON PRESTWOOD (CRNP)	Nurse Practitioner	AL
KIM S HUSSEY (NP)	Nurse Practitioner	FL